Understanding periviable birth: A microeconomic alternative to the dysregulation narrative

Ralph Catalano, Tim Bruckner, Lyndsay A. Avalos, Holly Stewart, Deborah Karasek, Shachar Kariv, Alison Gemmill, Katherine Saxton, Joan Casey

Research output: Contribution to journalComment/debatepeer-review

4 Scopus citations


Periviable infants (i.e., those born in the 20th through 26th weeks of gestation) suffer much morbidity and approximately half die in the first year of life. Attempts to explain and predict these births disproportionately invoke a “dysregulation” narrative. Research inspired by this narrative has not led to efficacious interventions. The clinical community has, therefore, urged novel approaches to the problem. We aim to provoke debate by offering the theory, inferred from microeconomics, that risk tolerant women carry, without cognitive involvement, high risk fetuses farther into pregnancy than do other women. These extended high-risk pregnancies historically ended in stillbirth but modern obstetric practices now convert a fraction to periviable births. We argue that this theory deserves testing because it suggests inexpensive and noninvasive screening for pregnancies that might benefit from the costly and invasive interventions clinical research will likely devise.

Original languageEnglish (US)
Pages (from-to)281-284
Number of pages4
JournalSocial Science and Medicine
StatePublished - Jul 2019
Externally publishedYes


  • Periviable birth
  • Reproductive suppression
  • Risk tolerance
  • Spontaneous abortion

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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